PALLIATIVE CARE. A Brief Intervention. Euan Paterson Macmillan GP Facilitator (Glasgow)

Transcription

1 PALLIATIVE CARE A Brief Intervention Euan Paterson Macmillan GP Facilitator (Glasgow) euan.paterson@ntlworld.com

2 or How to deal with the Palliative Care DES (plus epcs & ACP!)

3 Topics Palliative Care DES electronic Palliative Care Summary (epcs) Anticipatory Care Planning (ACP) Including My Thinking Ahead & Making Plans

4 Some problems The sudden deterioration What does the patient know / think / want? What do the family know / think / want? Lack of medication Blue light 999 at end of life Who knows what? The weekend catastrophe The bad death and then 4 hours to confirm it happened!

5 Some problems Failure to reach a DES target

6 Which patients is the Palliative Care DES for? Patients with supportive / palliative care needs Whoever the PRACTICE feel should be included! Palliative care register GSF register SPICT / GSFS prognostication guidance?

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8 Which patients is the Palliative Care DES for? Patients with supportive / palliative care needs Whoever the PRACTICE feel should be included! Palliative care register GSF register SPICT / GSFS prognostication guidance? Chronic disease registers? Care Home patients?? Housebound patients???

9 Palliative Care Codes epcs DS 1500 Disability living allowance completed 9EB5 Terminal care 8BA2 On gold standards palliative care framework 8CM1 Palliative treatment 8BJ1 Referred to community specialist palliative care team 8HH7 Terminal illness late stage 1Z01 Specialist palliative care treatment daycare 8BAS Refer for terminal care 8H7L Refer to terminal care consult 8H6A Specialist palliative care treatment outpatient 8BAT Specialist palliative care 8BAP Referral to palliative care service 8H7g Palliative care ZV57C

10 Palliative Care Codes Palliative Care Register All of epcs codes plus: Liverpool care pathway for the dying 8CM4 Anticipatory palliative care 8BAe On end of life care register 9Ng7 Has end of life advance care plan 8CME On gold standards palliative care framework 8CM1% Last days of life 2JE Referral to community palliative care team declined 8IEE

11 Palliative Care PC3 Records The practice has a complete register available of all patients in need of palliative care/support irrespective of age PC2 Ongoing management The practice has regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliative care register are discussed

12 Palliative Care DES Level 1 Patient cohort patients on palliative care register Anticipatory Care Plan (ACP) within 4 weeks Transfer ACP to OOH services within 4 weeks (epcs) Diagnoses Consent Review date

13 Palliative Care DES Level 1 Payment 68 per patient Not capped No payment for using LCP

14 Palliative Care DES - process Decide who should be on the PC register First obtain consent Then add data via epcs template (9 epcs) Z consent Check consent box Add palliative care review date E edit Highlight appropriate diagnoses T - treatment Add to Palliative Care Register

15 Palliative Care DES Level 2 Significant Event Analysis 1 per 1000/list Non-malignant Not on PC register (expected / unexpected) No epcs No DNACPR Preferred place of care / death LCP not used Reflective practice meeting 3 or more learning points What to do regarding learning points What needs to happen within your NHS Board area (!)

16 Palliative Care DES Level 2 Payment 250 administration 58 / SEA (max 1/1000/list)

17 Which patients is epcs for? Patients with supportive / palliative care needs Whoever YOU feel should be included! Palliative care register GSF register SPICT / GSFS prognostication guidance? Chronic disease registers? Care Home patients?? Housebound patients???

18 What is epcs for? Information transfer In Hours GP > OOH Primary Care > A&E / Acute Receiving Units Primary Care > Scottish Ambulance Service Prompts for proactive care Anticipatory Care Planning All data stored in one place Structure for lists / meetings / etc Palliative care DES

19 What does epcs contain? Information upload Palliative Care review date Consent to share information Current situation Diagnoses Key personnel involved Carer details Current treatment Repeat Last 30 days Acute Patient & carer understanding Diagnosis & Prognosis

20 What does epcs contain? Future Care Plan Preferred Place of Care Resuscitation status Additional drugs in house (Just in Case) Advice for OOH GP e.g. Contact own GP OOH GP willingness to sign death certificate Additional OOH information (KEY section) e.g. Patient wishes Starting Liverpool Care Pathway Etc

21 How to use epcs Decide who should have an epcs record First Obtain consent Then add data via epcs template (9 epcs) Z consent Check consent box Add palliative care review date E edit Highlight appropriate diagnoses T - treatment Add to Palliative Care Register

22 Anticipatory Care Planning (ACP) What is it? Why is it (possibly) more important in palliative care? Which patients is it for?

23 Which patients is it for? Patients with supportive / palliative care needs Whoever YOU feel should be included! Palliative care register GSF register SPICT / GSFS prognostication guidance? Chronic disease registers? Care Home patients?? Housebound patients???

24 Anticipatory Care Planning (ACP) What is it? Why is it (possibly) more important in palliative care? Which patients is it for? What are the components of ACP?

25 Anticipatory Care Planning Advance Care Planning Legal Personal Medical Welfare Power of Attorney Advance Statement Thinking ahead & making plans SPAR Potential Problems DNA CPR Continuing Power of Attorney Guardianship 1 Statement of values 2 Preferences & priorities 3 Advance decision to refuse treatment 4 Who else to consult GSFS epcs Just in Case Liverpool Care Pathway DN Verification of Death Anticipatory Care Planning

26 Legal Capacity Welfare Power of Attorney Continuing Power of Attorney Guardianship Consent To record To transfer Advance decision to refuse treatment

27 Clinical Consideration of potential problems What is likely to happen to THIS patient What might happen to THIS patient DNACPR Just in Case Proactive prescribing DN Verification of Expected Death Liverpool Care Pathway for the Dying Bereavement

28 Preferred priorities of care Place of care Admission Aggressiveness of treatment Place of death Who is to be involved Patient / Personal

29 Patient / Personal Advance statement Statement of values E.g. what makes life worth living What patient wishes E.g. place of care, aggressiveness of treatment What patient does not want E.g. PEG feeding, SC fluids, CPR Who they would wish consulted Process Gathering Sensitive consultations & discussion My Thinking Ahead & Making Plans Recording

30 The views and wishes of patient / carer My thinking ahead and making plans What is important to me just now Planning ahead Looking after me well My concerns Other important things Things I want to know more about Keeping track (who helped me) An advanced statement

31 Anticipatory Care Planning (ACP) What is it? Why is it (possibly) more important in palliative care? Which patients is it for? What are the components of ACP? ACP process When should this be done? Who should do it? How should it be done? How should it be shared?

32 ACP Process When should this be done? At any time in life that it seems appropriate Continuously Who should do it? By anyone with an appropriate relationship! How should it be done? My Thinking Ahead & Making Plans Carefully Write it down Transfer it (epcs) Communicate

33 The ACP Checklist Capacity Power of Attorney / Possible future problems? Have we considered What is likely & what might happen to this patient? Where the patient would like to be cared for? CPR / DNACPR? OOH information transfer (epcs) Have we considered the possible need for Anticipatory prescribing (Just in Case) RN Verification of Expected Death The Liverpool Care Pathway for the Dying The patient / carer view My Thinking Ahead & Making Plans